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bleeding risk

Sam Schulman, Peter L Gross, Bruce Ritchie, Susan Nahirniak, Yulia Lin, Lani Lieberman, Marc Carrier, Mark A Crowther, Indy Ghosh, Alejandro Lazo-Langner, Michelle Zondag
Oral factor Xa inhibitors are increasingly used for anticoagulation, but there is no approved reversal agent. Prothrombin complex concentrate (PCC) for the management of Xa-inhibitor-associated bleeding has been described in small case series and one cohort study. Patients on apixaban or rivaroxaban, suffering a major bleed, were treated at nine Canadian hospitals as per existing hospital protocol with a fixed dose of PCC 2,000 units and subsequently recruited for a 30-day follow-up. The treating physician evaluated the haemostatic effectiveness as observed during the first day as good, moderate or poor/none, using an assessment guide...
March 21, 2018: Thrombosis and Haemostasis
Ilaria Cavallari, Giuseppe Patti
Platelets and the coagulation cascade play key roles in initiation, amplification, and perpetuation of acute coronary syndromes (ACS). In the past few years, there has been great progress in ACS antithrombotic treatment with the introduction of novel anticoagulants (fondaparinux and bivalirudin), more potent P2Y12 inhibitors (prasugrel and ticagrelor) and protease-activated receptor antagonists (vorapaxar). Nonetheless, patients with ACS frequently have recurrent ischemic events despite the use of currently recommended dual antiplatelet therapy, revascularization procedures as appropriate, and other evidence-based secondary preventive measures...
March 21, 2018: Internal and Emergency Medicine
Ander Regueiro, Ignacio Cruz-Gonzalez, Armando Bethencourt, Luis Nombela-Franco, Jean Champagne, Luis Asmarats, Pilar Jiménez-Quevedo, Tania Rodriguez-Gabella, Juan Carlos Rama-Merchan, Rishi Puri, Gilles O'Hara, Josep Rodés-Cabau
PURPOSE: We aimed to evaluate the late clinical outcomes of percutaneous LAA closure in patients with atrial fibrillation (AF) and contraindication to oral anticoagulation. METHODS: Consecutive AF patients with contraindications to oral anticoagulation who underwent successful LAA closure between December 2008 and March 2013 at four centers were included. RESULTS: A total of 101 patients (median age 76 [IQR 69-80] years, 48% women, mean CHA2 DS2 -VASc 5 ± 2; HAS-BLED 4 ± 1) were included...
March 21, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Tagore Sunkara, Megan E Caughey, Vinaya Gaduputi
Melanosis of the stomach and duodenum is a rare entity and a striking finding diagnosed by upper gastrointestinal endoscopy. Here, we describe the case of an 83-year-old female, with a complicated medical history, who was referred to gastroenterologist to assess bleeding risk. From the endoscopy, it was determined that she had both melanosis gastri and duodeni. Although both are rare, gastric melanosis appears to be even more unusual than duodenal melanosis, with only a few reported cases documented in the literature thus far...
2018: Gastroenterology and Hepatology From Bed to Bench
Chenguang Li, Yi Shen, Rende Xu, Yuxiang Dai, Shufu Chang, Hao Lu, Lei Ge, Jianying Ma, Juying Qian, Junbo Ge
The safety and efficacy of bivalirudin during percutaneous coronary intervention (PCI) in high bleeding risk patients with chronic total occlusion lesions (CTO) has not been studied till date. The use of bivalirudin may increase the thrombotic events during CTO-PCI.Between May 2013 and April 2014, a total of 117 high bleeding risk patients with CTOs underwent PCI. Bivalirudin was used in 89 cases with different strategies, including standard usage, combination of heparin, and additional bolus of bivalirudin on the basis of standard usage...
March 20, 2018: International Heart Journal
Akihide Konishi, Mami Ho, Yuko Shirai, Haruki Shirato
A prospective randomized clinical trial showed that the BioFreedom stent (Biosensors International), which is a polymer-free and carrier-free drug-coated stent, was significantly superior to a bare-metal stent (BMS) in patients at high bleeding risk who were receiving a 1-month course of dual antiplatelet therapy (DAPT). However, the stent thrombosis rate (2.01% for BioFreedom vs. 2.20% for BMS) was 4-6-fold higher than that of approved drug-eluting stents based on real-world data in Japan. Furthermore, the frequency of stent thrombosis at more than 1 month with the BioFreedom stent was slightly higher than that at less than 1 month...
March 21, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Saadia Sherazi, Peter Kouides, Charles Francis, Charles Julian Lowenstein, Majed Refaai, Grace Conley, Brent Alan Johnson, Eugene Muchnik, Susan Lien, Howard Todd Massey, Jeffrey Dean Alexis
BACKGROUND: Bleeding is a major cause of morbidity in patients with continuous flow left ventricular assist devices (LVADs). We sought to identify clinical predictors of bleeding within the first year of LVAD implantation. METHODS: A prospective study was performed on 30 patients with HeartMate II implantation at the University of Rochester Medical Center, Rochester, New York, United States. Blood was collected within 1 week before implantation, and at 1, 3, and 30 ± 10 days after implantation...
March 1, 2018: International Journal of Artificial Organs
X Y Zhao, J X Li, X F Tang, Y Xian, J J Xu, Y Song, L Jiang, L J Xu, J Chen, Y Zhang, L Song, L J Gao, Z Gao, J Zhang, Y Wu, S B Qiao, Y J Yang, R L Gao, B Xu, J Q Yuan
Objective: To evaluate the predictive value of GRACE discharge score on the long-term out-of-hospital coronary thrombotic events (CTE) after percutaneous coronary intervention (PCI) with drug-eluting stents. Methods: Present study was a prospective, observational, single center study. 10 724 consecutive patients underwent PCI in Fuwai Hospital between January and December 2013 were included, stents were implanted with conventional method. After PCI, patients were prescribed aspirin 100 mg once daily indefinitely, and either clopidogrel 75 mg once daily or ticagrelor 90 mg twice daily for at least 1 year...
March 24, 2018: Zhonghua Xin Xue Guan Bing za Zhi
Jan Steffel, Peter Verhamme, Tatjana S Potpara, Pierre Albaladejo, Matthias Antz, Lien Desteghe, Karl Georg Haeusler, Jonas Oldgren, Holger Reinecke, Vanessa Roldan-Schilling, Nigel Rowell, Peter Sinnaeve, Ronan Collins, A John Camm, Hein Heidbüchel
The current manuscript is the Executive Summary of the second update to the original Practical Guide, published in 2013. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF), and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain...
March 19, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Jan Steffel, Peter Verhamme, Tatjana S Potpara, Pierre Albaladejo, Matthias Antz, Lien Desteghe, Karl Georg Haeusler, Jonas Oldgren, Holger Reinecke, Vanessa Roldan-Schilling, Nigel Rowell, Peter Sinnaeve, Ronan Collins, A John Camm, Hein Heidbüchel
The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-1507]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF) and have emerged as the preferred choice, particularly in patients newly started on anticoagulation...
March 17, 2018: European Heart Journal
Illce B Lázaro-Pacheco, Alfredo I Servín-Caamaño, José L Pérez-Hernández, Gabriela Rojas-Loureiro, Luis Servín-Abad, Fátima Higuera-DE LA Tijera
BACKGROUND: Acid suppression has been associated with adverse events; such as, enteric infections. Proton pump inhibitors (PPI) are frequently prescribed in patients with cirrhosis, but is unclear if PPI are associated with the development of bacterial infections in these patients. OBJECTIVE: To assess the impact of PPI intake on the development of bacterial, viral and fungal infections in patients with cirrhosis. METHODS: An observational, retrospective, historic cohort study...
January 2018: Arquivos de Gastroenterologia
Amir Wolff, Gabriel F Santiago, Micah Belzberg, Omri Emodi, Chad R Gordon
INTRODUCTION: Combined mid-face and nasal apparatus trauma injuries pose a significant challenge to airway patency (AW), in the immediate postoperative setting following fracture reduction. As such, the authors describe a modified technique with the goal of maintaining a patent nasal AW, while at the same time, minimizing nasopharyngeal bleeding and nasal AW edema-which can complicate patients requiring intermaxillary fixation (IMF) in the setting of pan-facial trauma. METHODS: A modified technique was devised to assist the reconstruction surgeon in avoiding the risks associated with tracheostomy placement...
March 20, 2018: Journal of Craniofacial Surgery
Pernille Just Vinholt, Anne B Alnor, Mads Nybo, Anne-Mette Hvas
: In thrombocytopenia, differences in haemostatic capacity may explain discrepancies in bleeding risk between patients with cancer and patients with liver cirrhosis. The objective was to compare the haemostatic capacity in different thrombocytopenic patient populations. We evaluated platelet aggregation using impedance aggregometry (Multiplate Analyzer), von Willebrand factor antigen (VWF:Ag), VWF:ristocetin-cofactor activity (VWF:RCo), activated partial thromboplastin time (aPTT), coagulation factor VIII, fibrinogen, and thrombin generation in adult hospitalized patients with platelet count less than 80 × 10/l...
March 19, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Caitlin S Brown, Wesley R Zemrak, Kaitlin J Dyer, Stephen Rolfe
Left ventricular assist devices (LVADs) have become an important advancement for patients with end-stage heart failure. Left ventricular assist devices come with the risk of stroke and pump thrombosis, and to mitigate these risks, anticoagulation is given to these patients. With anticoagulation comes increased bleeding risk, and urgent reversal may be necessary. Reports have shown that the risk of thrombosis with prothrombin complex concentrate (PCC) does exist, especially in patients with baseline risk factors for thrombosis...
March 20, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Kumar Rajnish, Sathasivam Sureshkumar, Manwar S Ali, Chellappa Vijayakumar, Sundaramurthi Sudharsanan, Chinnakali Palanivel
Introduction Laparoscopic cholecystectomy (LC) is the most commonly done, minimally invasive surgical procedure. Routinely used electrocautery produces more smoke, which masks the operating field, thereby prolongs the surgery and posing an increased risk of gallbladder (GB) perforation. The titanium clips used for clipping the cystic artery and cystic duct have a risk of slippage, which may lead to bleeding, and an increased risk for bile leakage. In addition, it may act as a nidus for stone formation. Advanced energy sources, such as the harmonic scalpel, though expensive, may provide the advantage of shorter operating time by reducing smoke, bloodless dissection in the GB bed, lower risk of bleeding from the cystic artery due to secure vessel sealing, and avoiding the use of a larger number of titanium clips...
January 18, 2018: Curēus
David R Vinson, E Margaret Warton, Dustin G Mark, Dustin W Ballard, Mary E Reed, Uli K Chettipally, Nimmie Singh, Sean Z Bouvet, Bory Kea, Patricia C Ramos, David S Glaser, Alan S Go
Introduction: Many patients with atrial fibrillation or atrial flutter (AF/FL) who are high risk for ischemic stroke are not receiving evidence-based thromboprophylaxis. We examined anticoagulant prescribing within 30 days of receiving dysrhythmia care for non-valvular AF/FL in the emergency department (ED). Methods: This prospective study included non-anticoagulated adults at high risk for ischemic stroke (ATRIA score ≥7) who received emergency AF/FL care and were discharged home from seven community EDs between May 2011 and August 2012...
March 2018: Western Journal of Emergency Medicine
Aneta Cymbaluk-Płoska, Anita Chudecka-Głaz, Anna Jagodzińska, Ewa Pius-Sadowska, Agnieszka Sompolska-Rzechuła, Bogusław Machaliński, Janusz Menkiszak
Introduction: Adipose tissue is considered an endocrine organ and produces a number of biologically active substances. Aims: To consider the role that four adipokines - leptin, omentin-1, vaspin, and galectin-3 - play in the diagnosis of endometrium cancer and to investigate the association between serum concentrations of adipose tissue metabolism products and the diagnostics and prognosis in endometrial cancer. Patients and methods: The study included 168 patients with body mass index (BMI) >20 kg/m2 admitted due to post-menopausal bleeding...
2018: OncoTargets and Therapy
Feifei Z Williams, Atul Vats, Thomas Cash, James D Fortenberry
Respiratory failure associated with hematopoietic stem cell transplantation (HSCT) has been considered a contraindication for use of extracorporeal membrane oxygenation (ECMO) at many centers. We describe a child with neuroblastoma and hypoxemic respiratory failure following HSCT who was successfully managed with veno-venous (VV) ECMO. The patient was an 18-month-old female with high-risk neuroblastoma status post tumor resection, chemotherapy, autologous HSCT, and primary site radiation. On day 113 posttransplant while receiving maintenance immunotherapy, she had an acute respiratory decompensation because of rhinovirus, aspiration pneumonia, and capillary leak syndrome...
March 2018: Journal of Extra-corporeal Technology
Hsin-Fu Lee, Yi-Hsin Chan, Hui-Tzu Tu, Chi-Tai Kuo, Yung-Hsin Yeh, Shang-Hung Chang, Lung-Sheng Wu, Lai-Chu See
BACKGROUND: Rivaroxaban (20 mg/15 mg once daily) is an effective and safe alternative to warfarin for stroke prevention in patients with non-valvular AF (NVAF). Low-dose rivaroxaban (15 mg/10 mg once daily) has been only approved for NVAF patients in Japan and Taiwan, although its effectiveness and safety at low doses remain unclear among Asians with NVAF. The objective of the study is to compare the effectiveness and safety of low-dose rivaroxaban to those of warfarin among Asians with NVAF...
March 14, 2018: International Journal of Cardiology
Hui Yin Lim, Harshal Nandurkar, Prahlad Ho
The advent of direct oral anticoagulants (DOACs) has revolutionized anticoagulation management in both stroke prevention and venous thromboembolism (VTE) treatment/prevention. Clinical trials and secondary real-world data have shown that DOACs have similar efficacy and, in some cases, improved bleeding safety profiles compared with vitamin K antagonists. Together with benefits of patient convenience, this has shifted the risk-benefit ratio toward long-term anticoagulation. However, current VTE risk assessment models are based on vitamin K antagonists and do not take into account the new paradigm of DOACs...
March 20, 2018: Seminars in Thrombosis and Hemostasis
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